<extend name="Base/common_ionic"/>
<block name="style">
<style>
</style>
</block>

<block name="body">
    <div class="bar bar-header bar-stable">
        <a class="button button-icon icon ion-ios-arrow-back" href="javascript:history.go(-1);"></a>
        <div class="h1 title">返利申请</div>
    </div>
    <div class="content has-header">
        <div class="item item-icon-left">
            <i class="icon ion-ios-information-outline"></i>
            <p>请输入您在我们app中已下单完成的订单号</p>
        </div>
        <div class="space-10"></div>
        <form class="list" method="post" action="{:U("Index/fanli_apply")}">
            <input type="hidden" value="{$clientid}" name="clientid" />
            <label class="item item-input">
                <input type="tel" placeholder="输入订单号" name="oid1">
            </label>
            <label class="item item-input">
                <input type="tel" placeholder="输入订单号" name="oid2">
            </label>
            <label class="item item-input">
                <input type="tel" placeholder="输入订单号" name="oid3">
            </label>
            <button type="submit" class="button button-block button-positive">提交</button>
        </form>
    </div>
</block>
